Providing CME Requires Effort, Attention, and Patience

Continuing medical education (CME) programs are important to healthcare professionals. Few of us realize how much work goes into producing a CME event that is meaningful and affordable while qualifying as AMA PRA Category 1 credit.

The Medical Association of State of Alabama (MASA) is one entity in the state that offers CME programs and accredits other organizations. "Our function is twofold: we accredit organizations to put on their own CME programs, and we work with organizations that are not accredited so they can award credit for their activities," said Judy DeBray, MASA director of education. "A lot people think that all you do to become a provider is fill out an application and submit it. We have to assure providers have the personnel and financial resources to produce a program, with policies and procedures in place. It can take a year to 18 months to become a fully accredited provider."

The process starts with pre-application, followed by an initial application to be approved for two years, after which the organization must reapply for full accreditation for four years. Following full accreditation, organizations must reapply every four years. (Six years for organizations who have achieved accreditation with commendation.)

CME providers must follow 13 criteria for their programs, and should show they are addressing gaps in knowledge. In addition, the provider must conduct a needs assessment and develop objectives that are given to the speakers. Also, presenters must disclose any conflict of interest issues.

Ten hospitals in the state are accredited CME providers. "The number seems low, but that's because of consolidation," DeBray said. "For instance, Brookwood Hospital used to be a stand-alone just like Baptist, but they have joined forces under the umbrella of one health system. So the number has gone down, but it doesn't affect the number of physicians and professionals who benefit from the activities."

Many institutions choose to implement their programs as a joint provider with an accredited entity such as MASA, rather than become fully accredited providers. As a joint provider, it's wise to begin the planning process at least 60 days prior to the activity date, said Diane Bass, director of programs and events.

Bass starts the process for a new joint provider with a conference call, once she receives the initial application. "I've had up to four conference calls to make sure everything is in place," she said. "MASA currently has 16 joint providers in the state that cover 26 activities."

Several of those joint providers were once accredited providers, but due to funding and staff cuts, they chose to make the change. Bass and DeBray said they often field questions from someone who thinks they want to offer CME activities as an accredited provider only to discover joint providership better meets their needs. And it can go the other way as well. "We provide counsel and work together to help. We try to make the process as simple as possible," Bass said.

In addition to accrediting other entities and offering joint sponsorship, MASA also offers their own CME activities. "We have offered a course on prescribing controlled drugs since 2009, putting Alabama ahead of the curve," DeBray said. "In 2012 the FDA required the pharmaceutical companies that made extended-release, long-acting opioids to develop risk evaluation and mitigation strategies. Other organizations scrambled to create programs to address this, but we had already been doing education on it for two or three years. [See related sidebar for more details.]

"We also do an activity for practices where physicians and nurse practitioners have a collaborative agreement. And we present medical ethics once a year. In addition, we do our own annual session. This year our annual session includes 13 activities around the state on MACRA."

Because the endeavor can be costly and time consuming, it is more common for a hospital to sponsor CME activities than a physician practice, but Cardiovascular Associates at Brookwood Baptist Health is one exception.

Andrew Miller, MD

"Cardiovascular Associates created the CVA Medical Education Foundation to bring education to physicians before 2006," said Rebekah Francis, conference coordinator with CVA Medical Education Foundation. "We enter into a joint partnership with Brookwood Baptist Health to offer a one-day annual event called Cardiovascular Update. We invite primary care physicians, internal medicine doctors and anyone who sees patients who could have cardiovascular disease. We educate the general practitioner on signs to look for and when to refer patients to a cardiologist."

Andrew Miller, MD, organizing chair, said that putting the annual update together is a year-long process. "We are working on the CME process now for the February program," he said. "It's an intense process to come up with the final product of a one-day meeting. I've been involved in CME programs for years, and it's still difficult."

Still, he says it is worth the effort. "We decided 10 years ago it was important to reach out to the community and provide medical education," Miller said. "Our conference is aimed to take cardiology to a bread and butter level to give applicable knowledge to primary care providers. We distill information they can take to their patients and directly apply at bedside to improve patient care. We think it's important, because we value cardiovascular health and it's the best way to spread our message."

Cardiovascular Update Conference

The 11th annual Cardiovascular Update Conference will be held on February 17, 2018. Topics include:

Beginning January 1, 2018, physicians with an Alabama Controlled Substances Certificate will be required to earn two AMA PRA Category 1 CME hours in controlled substances prescribing every year. MASA has offered a course on this topic for several years now.

"Some physicians prescribe too much of these drugs, while others don't prescribe enough out of caution. There's a lot of discussion in the medical community as to which way the pendulum is swinging," said Lori Quiller, MASA director of communications and social media.

"We offer our course three times each year in different areas of the state," said Judy DeBray, MASA director of education. "We change the content every year, so 75 percent of the content is brand new material."

Past presenters have included a former DEA agent, pharmacists, and physicians who had a hand in passing the recent legislation. "We offer extra knowledge from doctors who have done research and helped pass regulations," Quiller said.